The objective of the Operative Unit of the Head and Neck Oncology Area headed by Prof. Giovanni Almadori, within the Institute of Otolaryngology, is to provide a center of excellence for the treatment of head and neck tumours (6% of all malignant tumours). The center combines clinical excellence of care, results of cutting-edge biomedical research, and empathy for each patient.
In recent years, new knowledge on the pathogenesis of tumours, technological and pharmacological progress and the possibility of new surgical approaches, have increased the therapeutic weapons against these tumours.
The therapeutic choice is strongly conditioned by the stage of the disease, the histology, the location of the disease and the possibilities of the best organ preservation and function obtainable.
90% of head and neck cancers originate from the squamous cells of the epithelium lining the respiratory mucosa of the cervico-facial area (oral cavity, oropharynx, nose and paranasal sinuses, nasopharynx, pharynx-hypopharynx, larynx) and are histologically called squamous cell carcinomas.
In 2008, there were more than 600,000 new cases with more than 350,000 deaths worldwide 2008, recording a significant increase in the incidence of these cancers, especially in women, although these cancers affect men more frequently. An emerging phenomenon is the appearance of tumours among people who have never smoked. The incidence is higher in patients aged 60-70, but recently there has been an increase in incidence in younger subjects (under 40) and in older ones (over 80).
Unfortunately, head and neck cancers are still frequently diagnosed late and therefore treated in an advanced stage of the disease, negatively affecting the therapeutic results with the risk of non-cancer control. For this reason, the timely recognition of clinical signs and symptoms by patients and general practitioners and the consequent referral to the otolaryngologist, an expert in oncology, represents the fundamental prerequisite for early diagnosis and for the choice of an adequate treatment that offers the highest probability of clinical cure.
Noticing a tumour early, when it is in its earliest stages, means having a greater chance of healing (over 90% in the case of head and neck cancer), with less invasive treatments. Yet many men and women, who have smoked for over 20 years and who continue to smoke, do not regularly carry out those simple primary prevention tests aimed at providing personalized paths useful for adopting more correct lifestyles that help protect their health.
Voice, language and swallowing therapists are key figures in these patients therapeutic-rehabilitation team.
Physiotherapists and occupational therapists help patients to improve their mobility after surgery or after chemo-radiation treatments. Expert therapists of the Gemelli Polyclinic work in great synergy with patients and their families, and with doctors, in order to increase the quality of life both during treatments and after the disease.
Therapists evaluate the needs of each oncology patient and design an individual rehabilitation plan, specific to each individual patient, during their treatment program or during their hospitalization.
They often prescribe specific exercises to help patients improve articulation (language and pronunciation), swallowing, posture, degree of mobility, and the strength of the neck and shoulder muscles, after both surgical and radiotherapy treatment.
They also provide treatments to improve the effectiveness of swallowing, speech, breathing and coughing after surgery, and provide assistive devices to help the patient walk. These figures therefore play an important role in educating patients to reacquire the mechanics of their bodies, to save energy and to acquire pain management techniques, all in order to reduce the side effects of surgery or hospitalization. They can also suggest specific precautions to be observed after the surgery.
Following the treatment, the patient should notice changes in their mobility, strength, flexibility, balance and endurance. Occupational therapists educate patients and their families about these changes and how to use their equipment and compensatory techniques to increase patient independence during their routine daily activities. They also teach the patient techniques to fully recover some basic activities during the day, such as washing, dressing, and moving around. Some patients may notice a decrease in hearing, sight, smell and taste after surgery; rehabilitation therapists also offer support in this regard.
The members of the head and neck team work in synergy with the "Center's Integrative Medicine Services". For example, research done at the Gemelli polyclinic has shown that acupuncture could be helpful for symptoms related to the neck and shoulders, as well as for dry mouth after radiotherapy.
At the Gemelli Polyclinic, we offer a complete follow-up service carried out weekly at the Oncology Clinic of the Otolaryngology Clinic. The follow-up service is carried out jointly by otolaryngologists and radiotherapists for oncological control and by speech and speech therapists for functional control.
In addition, to monitoring signs of disease recurrence, the doctor focuses on identifying, preventing and controlling any effects associated with the treatment of the disease. The visit with the ENT specialist therefore includes:
To work together with the whole team, the otolaryngologist informs not only the person concerned about the treatment, but also the referring doctor and other doctors, who are continuously updated.